Healthcare Provider Details

I. General information

NPI: 1952469629
Provider Name (Legal Business Name): SARA CATHERINE BULL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 1ST AVE STE 9V
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

PO BOX 60122
CHARLOTTE NC
28260-0122
US

V. Phone/Fax

Practice location:
  • Phone: 646-501-0197
  • Fax: 704-347-5261
Mailing address:
  • Phone: 704-373-0212
  • Fax: 704-347-5261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number381379
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: